Provider Demographics
NPI:1326210261
Name:KENDRIC R. KAJIKAWA, O.D. INC
Entity Type:Organization
Organization Name:KENDRIC R. KAJIKAWA, O.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:KENDRIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:KAJIKAWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-446-5235
Mailing Address - Street 1:145 E DUARTE RD STE D
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-6691
Mailing Address - Country:US
Mailing Address - Phone:626-446-5235
Mailing Address - Fax:626-446-5255
Practice Address - Street 1:145 E DUARTE RD STE D
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-6691
Practice Address - Country:US
Practice Address - Phone:626-446-5235
Practice Address - Fax:626-446-5255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6473T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6473TOtherOTOMETRY LICENSE
CADQ5607Medicare PIN
CABE765AMedicare PIN
CAU24089Medicare UPIN
CA6092950001Medicare NSC